Primary peg-filgrastim prophylaxis versus filgrastim given “on demand” for neutropenia during therapy with cladribine for hairy cell leukemia

Tadmor, Tamar; Levy, Ilana; Herishanu, Yair; Goldschmidt, Neta; Bairey, Osnat; Yuklea, Mona; Shvidel, Lev; Fineman, Riva; Aviv, Ariel; Ruchlemer, Rosa; Braester, Andrei; Dally, Najib; Rouvio, Ory; Shaulov, Adir; Inbar, Michal; Polliack, Aaron

doi:10.1016/j.leukres.2019.05.006

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…These results seem concordant with a recent retrospective study investigating the impact of prophylactic versus “on demand” filgastrim in 159 2-CdA-treated HCL patients. The authors demonstrated similar rates of infections, need for hospitalization, and nadir duration in both cohorts, suggesting insufficient benefit for prophylactic G-CSF administration [ 17 ]. Accordingly, both approaches seem justifiable and are chosen at the physicians discretion.…”

Section: Discussionmentioning

confidence: 99%

Hairy Cell Leukemia Patients Have a Normal Life Expectancy—A 35-Year Single-Center Experience and Comparison with the General Population

Bohn

Neururer

Pirklbauer

et al. 2022

Cancers

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Classic hairy cell leukemia (HCL) is an uncommon hematologic malignancy characterized by an excellent prognosis since purine analogues (PA), such as cladribine (2-CdA), have been introduced in the 1990s. However, most data on long-term outcomes is gathered from patients treated with PA first-line or include limited information on previous treatment outcomes, i.e., Interferon-α (IFN-α). Survival curves from previous series did not reach a plateau, indicating that nearly all patients ultimately relapse. Yet, overall survival (OS) data were rarely corrected for life expectancy of the general population. We here report 83 consecutive HCL patients treated between 1983 and 2017 at the University Center in Innsbruck, Austria. Median follow-up was 170 months (1–498). IFN-α, the first-line treatment of choice before 1990, was administered to 24 patients, achieving an overall response rate (ORR) of 86% and an unconfirmed complete remission (CRu) in 23%. All these patients relapsed after a median progression-free survival (PFS) of 30 months (3–80), but either remained drug-sensitive upon re-exposure to IFN-α or were successfully salvaged with PA. All 42 patients exposed to first-line 2-CdA responded (ORR of 100%). Sixteen patients received two to four successive courses of PA with a continuous decrease in the response quality (CRu rate 85.7% 1st-line vs. 41.5% 3rd-line treatment). Median PFS was not reached in both treatment-naïve patients and those retreated at first relapse. Although pretreatment with IFN-α was associated with a shortened median PFS of 81 months (43–118) after PA therapy, this tendency of inferior PFS did not result in inferior OS. OS of all 83 patients was excellent and equivalent to that of age-, sex-, and diagnostic period-matched controls from the Tyrolean general population (standardized mortality ratio 0.8), regardless of their age at diagnosis or whether they were diagnosed until or after the year 2000. These results confirm that HCL patients may look forward to a normal lifespan when treated with PA irrespective of their pretreatment history.

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Section: Discussionmentioning

confidence: 99%

Hairy Cell Leukemia Patients Have a Normal Life Expectancy—A 35-Year Single-Center Experience and Comparison with the General Population

Bohn

Neururer

Pirklbauer

et al. 2022

Cancers

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“…In total, 12 RCTs [9-20] and 6 non-RCTs [21][22][23][24][25][26] compared the incidence of FN between single-dose PEG G-CSF and multiple-dose non-PEG G-CSF. The meta-analysis using 12 RCTs revealed a signi cant decrease in the incidence of FN in patients who received a single dose of PEG G-CSF (RR = 1.18, 95% CI = 1.03-1.34, P = 0.01, Fig.…”

Section: Relationship Between the Incidence Of Fn And The Type Of G-csfmentioning

confidence: 99%

Comparison between a single dose of PEG G-CSF and multiple doses of non-PEG G-CSF: a systematic review and meta-analysis from Clinical Practice Guidelines for the use of G-CSF 2022

Yoshinami,

Nozawa,

Yokoe

et al. 2024

Int J Clin Oncol

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Granulocyte colony-stimulating factor (G-CSF) is widely used for the primary prophylaxis of febrile neutropenia (FN). Two types of G-CSF are available in Japan, namely G-CSF chemically bound to polyethylene glycol (PEG G-CSF), which provides long-lasting effects with a single dose, and nonpolyethylene glycol-bound G-CSF (non-PEG G-CSF), which must be sequentially administrated for several days. This current study investigated the utility of these treatments for the primary prophylaxis of FN through a systematic review of the literature. A detailed literature search for related studies was performed using PubMed, Ichushi-Web, and the Cochrane Library. Data were independently extracted and assessed by two reviewers. A qualitative analysis or meta-analysis was conducted to evaluate six outcomes. Through the rst and second screenings, 23 and 18 articles were extracted for qualitative synthesis and meta-analysis, respectively.The incidence of FN was signi cantly lower in the PEG G-CSF group than in the non-PEG G-CSF group with a strong quality/certainty of evidence. The differences in other outcomes, such as overall survival, infection-related mortality, the duration of neutropenia (less than 500/µL), quality of life, and pain, were not apparent. Therefore, a single dose of PEG G-CSF is strongly recommended over multiple-dose non-PEG G-CSF therapy for the primary prophylaxis of FN.

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Comparison between a single dose of PEG G-CSF and multiple doses of non-PEG G-CSF: A systematic review and meta-analysis from Clinical Practice Guidelines for the Use of G-CSF 2022

Yoshinami,

Nozawa,

Yokoe

et al. 2024

Preprint

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Granulocyte colony-stimulating factor (G-CSF) is widely used for the primary prophylaxis of febrile neutropenia (FN). Two types of G-CSF are available in Japan, namely G-CSF chemically bound to polyethylene glycol (PEG G-CSF), which provides long-lasting effects with a single dose, and non-polyethylene glycol-bound G-CSF (non-PEG G-CSF), which must be sequentially administrated for several days. This current study investigated the utility of these treatments for the primary prophylaxis of FN through a systematic review of the literature. A detailed literature search for related studies was performed using PubMed, Ichushi-Web, and the Cochrane Library. Data were independently extracted and assessed by two reviewers. A qualitative analysis or meta-analysis was conducted to evaluate six outcomes. Through the first and second screenings, 23 and 18 articles were extracted for qualitative synthesis and meta-analysis, respectively. The incidence of FN was significantly lower in the PEG G-CSF group than in the non-PEG G-CSF group with a strong quality/certainty of evidence. The differences in other outcomes, such as overall survival, infection-related mortality, the duration of neutropenia (less than 500/µL), quality of life, and pain, were not apparent. Therefore, a single dose of PEG G-CSF is strongly recommended over multiple-dose non-PEG G-CSF therapy for the primary prophylaxis of FN.

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Primary peg-filgrastim prophylaxis versus filgrastim given “on demand” for neutropenia during therapy with cladribine for hairy cell leukemia

Cited by 3 publications

References 23 publications

Hairy Cell Leukemia Patients Have a Normal Life Expectancy—A 35-Year Single-Center Experience and Comparison with the General Population

Hairy Cell Leukemia Patients Have a Normal Life Expectancy—A 35-Year Single-Center Experience and Comparison with the General Population

Comparison between a single dose of PEG G-CSF and multiple doses of non-PEG G-CSF: a systematic review and meta-analysis from Clinical Practice Guidelines for the use of G-CSF 2022

Comparison between a single dose of PEG G-CSF and multiple doses of non-PEG G-CSF: A systematic review and meta-analysis from Clinical Practice Guidelines for the Use of G-CSF 2022

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